How Many People In The Hospital Are Alcoholics?

That is a question I can't answer.

I can tell you that in the past two weeks I've had two patients who came in for scheduled surgery who were heavy drinkers. Both had 3-4 drinks a day, but only one suffered from DT's.

Let's see what the internet can show us.

While doing a very brief and limited search to find out if there are any studies leading me to the stats I came across this article: "Alcoholics Risk Infection After Heart Surgery" and in it states that 20-30% of people in the hospital are alcoholics. It's interesting to note that the highest prevalence is detected in the third to fifth decade of life, and also that the risk of surgical complications due to alcohol increase with simply 60 grams of alcohol a day (3 glasses of beer or wine.)

This is also an interesting abstract on, "The Alcohol Patient and Surgery." Wow. I wonder how much money they are talking about when they say the economic implications are tremendous.

Poor Hand-Off

I was not pleased a couple days ago when I had to transfer a patient to another floor. They had been with us for about 15 minutes when the patient informed us that they had tested positive for MRSA within the past few weeks in the doctor's office. This was not good as the patient was in a semi-private room and the roommate was free of all bugs. I had to get the patient with MRSA out of there and into a private room. After looking at the bed situation we had no private rooms available, and there were no possible bed moves to be made to alleviate the situation. So, I called admitting to see if we could find this patient a different floor to move to. We knew we'd be getting the patient post-op, but at least this would buy us another day to move some people around and hopefully have a bed available.

About 2 hours later I finally am able to make the transfer. As I'm giving report to the other nurse it's clear that they are less than thrilled about having to take this patient, and they immediately put me on edge with this comment: "He probably knows what to say to get a private room without having to pay for it." Excuse me? Does this other nurse seriously think that a patient with underlying dementia (yes, I already told her that in report) is with it enough to come up with an elaborate scheme to get a private room? The next question she posed after I explained in the kindest way possible why he was indeed MRSA positive was, "Don't you guys have any private rooms?"

At that point I wanted to go up there and speak to this nurses face-to-face. Does she really believe that I'm that stupid to have not put him in a private room or do bed changes if it was an option? I was completely taken aback and actually had to pause to put together my response. It was incredibly difficult for me to keep my composure and not respond the way I really wanted to her patronizing questions. But I did because it is important not to take things personally. This nurse was just upset that she had to take another patient and was dealing with it in her own way.

As charge nurse one day a mother of a patient comes out to see me, visibly upset. I ask what is wrong and what I can do to help. She informs me that her daughter is very upset as to who her nurse will be (just changed shift) for the rest of the day and wanted somebody else to have her. I immediately said I would be happy to have her as my patient and we talked further about the situation and why they didn't want the nurse originally assigned.

Not a huge deal, sometimes there are just personality conflicts or it is not a good fit. I am reminded of my days waiting tables when sometimes no matter what you did the table would not like you and you weren't going to be making any money. As waitstaff if you were in one of those situations it was always wisest to let your manager know and potentially switch waiters. But what do you do with nurses and suddenly you are the "manager"?

How do you tell another nurse that their compassionate care they gave a patient the day before was viewed as inadequate by the patient? How do you tell them that the patient wants somebody else?

Alcohol Dependence

My patient looked at me one morning with a questioning look in her eye and wanted to talk about what had happened during her hospitalization. I was wondering how much she really wanted to hear, so I started slowly to gauge her reactions and tread very carefully with my terminology. I avoided the term alcoholic and instead used alcohol dependence. It just has a nicer, less-pointing-finger sound do it.

She was shocked to hear that the amount of alcohol she drank each day (3-4 glasses of wine) had an effect on her that caused her to go into DT's (Delirium Tremens) after surgery when her body wasn't getting the alcohol it was used to and needed. I then went on to explain how it could be dangerous and how we treat it with a drug called Ativan. She was shocked to hear that so much had gone on as she doesn't remember much about her time in the ICU. What she does remember she described it like being part of the movie "Invasion of the Body Snatchers."

At this point it is always so tricky, because you know they are a serious alcoholic, and that they have not a clue as to how much they are hurting themselves. It's a difficult conversation to have as you want to keep them from becoming defensive but you want to be honest with them. I was more than caught off guard when the patient told me that she never wanted to go through anything like that again. I took it as a chance to tell her that the withdrawal period was awful and that we had helped her get through it. Now came the time when she had to decide how she was going to live her life once she got home.

I started on the route of the drinking in moderation talk, the one where you let them know that they have to cut down or stop without going anywhere near those judging statements. In the end it was her who called me out and said, "Wouldn't it be better if I just stopped altogether?" I was blown away. I immediately offered to get her information, and when her husband came in I explained to him all that we had just discussed. It was the closest thing to an intervention that I have ever been involved with, and I with her the best of luck in her new sobriety.

Voyeuristic Site

I'm not sure if anybody is aware of this, but blogger has a site that simply shows photos that are being uploaded to their public blogs in real time. Very interesting, always something different, great distraction.

http://play.blogger.com/

Can You Wait A Second?

This is an oh-so-common happening. I want to preface by saying that in the following I will not at all exaggerate the timing of the events. In true scientific nature I will report clean, unadulterated data.

I answered a call light today, and the patient was rather gruff sounding and needed her nurse "Urgently to get back in bed." Now, it's rather common for patients to be in a chair expanding their lungs for 2 minutes and requesting to get back in bed (and just asking for a nasty bout of pneumonia) so we learn to check with the nurse who has the patient about the situation before putting a patient back into bed for them. I hang the call light up, and immediately seek out the nurse who is taking care of the patient. Less than a minute later and I've found her and am describing what just happened and asked her what she'd like me to do. The nurse then partially smiled and told me about the patient's anxiety, and that she hasn't been up long and needed to stay longer. So, about another minute later (less than 2 minutes total from hanging up the call light) I was on the way to the patients room--which was conveniently next to the nurse's station.

I'm about 5 steps from the doorway to the room, I can see the patient at this time, and I watch her push her call button again and re-demand to see her nurse. Talk about a little trigger happy! I did as any good nurse would do, explained the reasoning for her to be in the chair and got her to agree to stay in it for "A bit longer" (always being vague in exactly how long that will be.)

As I walked away after the intervention I hear her AGAIN push the call button.

And patients wonder why we sometimes don't answer call lights. It's because we can't get to them thanks to all the other patients who have anxiety and cry wolf!!

What To Do?

I was presented with a dilemma recently in theory, haven't personally been in this situation. However, I may be, and I'm curious as to what people think.

In the United States as healthcare providers it is ingrained in us to never-EVER practice outside our training. That means that if you are a pediatrician you shouldn't be removing somebody's gallbladder in surgery. We are specialists rather than a jack-of-all-trades kinda practitioner.

In the developing world it is not often the case. Sometimes, you may be the only person with any healthcare training at all. So what would you do if you were a doctor, but not a trained OB/GYN. There you are in the field and a woman presents in obstructed labor. You've seen a cesarean section twice, and you have a book that details how to do the procedure. There is no other place for her to go, the nearest hospital would be a 2 day trip away. What would you do?

Doctors v. Nurses

In my time working as a nurse I've rarely ever personally experienced any of that Doctor v. Nurse agenda that can cause rifts between the groups of professionals. But today I got a dose I didn't even see coming.

First of all, I don't think the person making the comment had any idea at all that it would be found so offensive. Second, the doctor in question did mean what he said, and was a bit appalled by the situation being described to him. The exact comment was, "You mean you worked as a floor nurse when you were a licensed nurse practitioner? How could you DO that!!" I'm very proud of my colleague in the polite, educated way she responded. I, however, was ready to give a returning dose of something to the doctor in question.

To defend the doc's side, I don't think he actually knew what it is that nurses really do all day. I don't think he has had many of the moments of deep connection with patients that nurses thrive on, because if he did there would have been more respect. I also don't think he understands what it is like to coordinate the kind of care that we do and what it takes for a nurse to do their job well. I don't fault him for this, I fault his training. As a resident he is whisked in and out of rooms with nary time to retract his pen between patients on morning rounds. As student nurses we are sent into rooms at times for the sole purpose of learning how to connect with patients.

To be fair there are many physicians I've encountered who are more than willing to collaborate with nurses and understand what we do. They know how we are each valuable in different ways to the care and comfort of our patients, and that by working together with other members of the care time we can offer the best outcomes for our patients. These are also the same physicians who I have seen hold patients hands and spend extra time with them whenever needed.

The doctor in question isn't one of them. Well, not today anyway.

Saying Goodbye

It's strange how once you change a patient's status from a full-code to a DNR that the patient sometimes suddenly perks up. I wonder if it is because they are preparing themselves for their departure. Most likely it has a lot to do with the sudden increase in visitors, the chance to say goodbye, the chance to enjoy life for one more brief period of time on their terms.

It's hard to say goodbye.

Frustrations With Drug Seekers

Some days it is just difficult to do your job, especially when taking care of a drug seeking patient who makes the rounds of the various ED's across the city looking for a fix. It's awful that he knows exactly what to say (abdominal pain) to get what can be a lengthy work-up and at least a few doses of narcotics. Once admitted, he simply refuses to leave after everything comes up negative, still complaining of pain and requesting narcotics. Eventually, we have to refuse him, and only when he is frustrated with our care will he leave. And why would we work-up an individual who we know is drug seeking? Because what if this time something really is wrong and we refused to treat him. Can you imagine the repercussions?

For those who work in healthcare, I can see your heads nodding up and down in agreement and frustration.